Provider Demographics
NPI:1639345788
Name:HUNTSVILLE EYE INSTITUTE
Entity Type:Organization
Organization Name:HUNTSVILLE EYE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-883-1029
Mailing Address - Street 1:964 AIRPORT RD SW STE 12
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1393
Mailing Address - Country:US
Mailing Address - Phone:256-883-1029
Mailing Address - Fax:
Practice Address - Street 1:964 AIRPORT RD SW STE 12
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1393
Practice Address - Country:US
Practice Address - Phone:256-883-1029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR EYE INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS943TA508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU84404Medicare UPIN